Thiam A, Diagne M, Ndiaye Ng, Ngom Gueye N F, Diakhate N D, Sow P S, Ndiaye I P
Clinique Neurologique, CHU de Dakar, Sénégal.
Dakar Med. 2005;50(3):176-82.
In order to appreciate the antiretroviral drugs impact in the HIV positive patients with peripheral neuropathy, a clinical, electrophysiological and neurpathological study of nerve biopsies was performed.
A group of 8 HIV seropositive patients with peripheral neuropathy was compared with an other group of 10 HIV seropositive patients treated with multiple antiretroviral drugs. Electrophysiological examination with motor nerve conduction velocity (MNCV) mesure of the median and the sciatic popliteal nerve was followed by nerve biopsy. Nerve fragments carried out the neuropathological technics for morphological examination.
Eighteen seropositive HIV patients (16 HIV-1 and 2 HIV-2) were included in this study. Six patients among them had motor and sensitive neuropathy of the four limbs and 2 patients had sensitive neuropathy associated with pyramidal signs. In fine, 1 patient had sensitive neuropathy with distal amyotrophy of the four limbs. Slow MNCV was observed in all the patients and more severe in the lower limbs. Nerve were unexciting in the lower limbs in 2 patients. Nerve biopsy showed severe axonal loss in all the patients treated but one. They associated axonal lesion in 5 cases and myelinated lesions in 2 cases. Two patients non treated had normal nerve biopsy. Axonal loss was mild in 2 cases and very severe in one case associated with non inflammatory demyelinated lesions.
we observed more severe and more frequent nerve lesions in treated patients than in no treated patients, as at the clinical, electrophysiological and neuropathological examination. Antiretroviral drugs cause more frequently pain motor and sensitive neuropathies at usual posologies. The occurence of recrudescence of pain peripheral neuropathy under antiretroviral treatment allows to reconsider drugs posologies.
为了评估抗逆转录病毒药物对HIV阳性伴周围神经病变患者的影响，我们进行了一项关于神经活检的临床、电生理和神经病理学研究。
将一组8例伴有周围神经病变的HIV血清阳性患者与另一组10例接受多种抗逆转录病毒药物治疗的HIV血清阳性患者进行比较。先对正中神经和坐骨-腘神经进行运动神经传导速度（MNCV）测量的电生理检查，然后进行神经活检。对神经碎片进行神经病理学技术检查以进行形态学检查。
本研究纳入了18例HIV血清阳性患者（16例HIV-1和2例HIV-2）。其中6例患者有四肢运动和感觉神经病变，2例患者有感觉神经病变伴锥体束征。最后，1例患者有感觉神经病变伴四肢远端肌萎缩。所有患者均观察到MNCV减慢，下肢更为严重。2例患者下肢神经无反应。神经活检显示，除1例患者外，所有接受治疗的患者均有严重的轴突丢失。其中5例伴有轴突病变，2例伴有髓鞘病变。2例未接受治疗的患者神经活检正常。2例患者轴突丢失轻微，1例患者轴突丢失非常严重并伴有非炎性脱髓鞘病变。
在临床、电生理和神经病理学检查中，我们观察到接受治疗的患者比未接受治疗的患者神经病变更严重、更频繁。抗逆转录病毒药物在常用剂量时更常引起疼痛性运动和感觉神经病变。抗逆转录病毒治疗期间周围神经病变疼痛复发的发生促使我们重新考虑药物剂量。
